Provider Demographics
NPI:1487679643
Name:MARTIN, JOE ALAN (MD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:ALAN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 E GREENVILLE ST
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1580
Mailing Address - Country:US
Mailing Address - Phone:864-226-9193
Mailing Address - Fax:864-231-0281
Practice Address - Street 1:726 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:SC
Practice Address - Zip Code:29627-2131
Practice Address - Country:US
Practice Address - Phone:864-226-9193
Practice Address - Fax:864-716-6732
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1233Medicaid
SC4871OtherMEDICARE GROUP ID
SCTL2223Medicaid
SC080189459OtherMEDICARE RR RETIREMENT
SCE235927117Medicare UPIN
SC7117Medicare ID - Type Unspecified
SCTL2223Medicaid